Provider Demographics
NPI:1629580519
Name:JOHNSON, BRIDGETT MICHELLE (APRN)
Entity type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:MICHELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10380 SW VILLAGE CENTER DR STE 215
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-1931
Mailing Address - Country:US
Mailing Address - Phone:929-491-7333
Mailing Address - Fax:929-491-7333
Practice Address - Street 1:1481 MCDONALD AVE FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4667
Practice Address - Country:US
Practice Address - Phone:929-491-7333
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-31
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020396363LP2300X
FL11015365363LP2300X, 363LG0600X
NJ26NJ14875500363LG0600X
TX1057450363LP2300X
NM74494363LG0600X, 363L00000X
FL9382157163W00000X
NY310606363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health